Friday, May 9, 2008

The King of Industry Supplements and I

John Shelton, PhD, may well be one of the most influential people in the field of psychiatry—though he is not a psychiatrist, and you may never have heard of him. He is the publisher of the Journal of Clinical Psychiatry, and is thus, in my mind, both Dr. Jekyll and Mr. Hyde. Jekyll-wise, he produces an excellent journal, brimming with clinically relevant articles covering topics that front-line psychiatrists care about (as opposed to, for example, Archives of General Psychiatry, which is filled with basic science articles).

But in his Mr. Hyde persona, he publishes dozens of industry-supported CME Supplements, each of which is an advertisement for a product marketed by the sponsoring company. I’ve never been shy about criticizing these supplements (here), and nor have other critics (here).

As I walked by the J Clin Psych booth at the APA meeting earlier this week, I saw Dr. Shelton in the flesh, and went up to him and introduced myself. He is a slim gregarious man with white hair and a ready smile, but when he looked at my name tag, he frowned. “The blogger!” he exclaimed. “There he is.” Surprised that he knew me right off the bat, I was a little flustered, and said, “Yep, that’s me….and I wanted to thank you for accepting my letter.” (I was referring to a soon-to-be-published letter in which I complain about bias in this recent BMS-funded supplement). “Look,” he said, “we put your letter through our review process, which is what we do for all our articles.”

The conversation was brief but cordial. I reiterated that I have no problem with the main journal but that the supplements appear to be promotional, almost without exception. He and Jane Eckstein, who is the director of their CME operation, maintained that the content is developed completely independently of drug company input. This is the standard bone of contention between those on different sides of the commercial CME divide, and both arguments are predictable, so I didn’t tarry long at the booth.

As I left, I realized that it all depends on what you define as “bias.” If you define it as inaccurate information, then Shelton and Eckstein are correct, since their supplements are carefully vetted for accuracy. But if you define it as manipulating the choice of accurate information to serve a promotional objective, then Team JCP is guilty as charged, since each supplement covers a topic of commercial benefit to the sponsor, and information is chosen to highlight advantages of the sponsor’s product.

To argue that the information is accurate and helpful to readers is not relevant. The information in drug ads is also accurate (the FDA makes certain of that) but nobody would argue that they are not also promotional.

Dr. Shelton mentioned that commercial CME covers important off-label uses, which FDA forbids companies to discuss (although recent guidelines may change this). But, in fact, doctors who don’t participate in industry CME are also free to teach about off-label uses, and they do so, frequently.

The debate will continue. And while I believe that you are doing the wrong thing, Dr. Shelton, I applaud you for being willing to engage with the “enemy”!

I think you're shortchanging the CME audience a little. Most psychiatrists understand that sponsored material has a certain amount of informational cherry picking. Few, if any, are willing to make a patient recommendation without first examining some unbaised clinical research - research which you acknowledge is available in Dr. Shelton's JCP.

I am not commenting to intiate dialogue, just educating: read the following piece and think about it regarding the meds here in the US.www.baltimoresun.com/news/opinion/oped/bal-op.heparin09may09,0,3,356719.story

Drug Safety Crisis that discusses ingredients (outsourcing)and tainted medications ? For example, this is a problem with Seorquel when one of the main ingredients was outsourced to China. How do you think we and not just psychiatric consumers, as all drugs are not immune to tainted ingredients--we should tackle this situation? The FDA ? who is really acountable here? Once again the pressure lays upon the patient to watch their backs, and I don't think that's right. The story depicts a person calling the nurse for help when given a bad batch of Heparin. What if she didn't have the ability to reach for the call button or even question things? Who is really taking care of patients and I believe doctors are swept up in this Pharmaceutical crap as much as consumers, somewhere "at the top" needs to be a little more effort placed to keep us safe from ALL medications. Is that not the FDA? because so far it sure seems that Pharma has us all bought and paid for with a lot of risk attached.

Why does Supremacy Claus cite a new venture sponsored by a throwaway tabloid and chaired by the very person most highly associated with biased CME? What does that have to do with the Baltimore Sun article about sourcing drug from China? Is there an association here?

The left opposes brand name drug promotion. It biases doctors into needlessly prescribing expensive brand names, to increase corporate profits.

Then a Commie propaganda organ, the Baltimore Sun has an article calling cheap imported ingredients for medication lethal and otherwise dangerous.

So the citation of the article suggests that ... What does it suggest? What should doctors do under coercive and threatening treatment by the left? Should they prescribe cheap imports or should they prescribe expensive and safer brand names after someone gave them a sandwich?

Fact:May 2008 issue of Current Psychiatry had 55 pages of articles/table of contents to its 128 total pages, most of the filler ads for psychotropics. So less than 45% was informative print? What does that say about the role of pharma in these mailer journals? Still seems more important than CME issues.

Sorry to see my posting about the Zimmerman article was not approved by the blog's author. I thought it was important to know about.

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About Dr. Carlat

I am a psychiatrist in Newburyport, Massachusetts and an Associate Clinical Professor of Psychiatry at Tufts Medical School (but note that the opinions expressed in this blog are not those of Tufts). I graduated from the psychiatric residency at Massachusetts General Hospital in 1995, and am the founder and publisher of three CME newsletters, including The Carlat Psychiatry Report. In March 2012, I left the publishing world to work on conflict of interest issues for The Pew Charitable Trusts, as director of the Pew Prescription Project. I returned to Newburyport and Carlat Publishing in September 2014.